Evaluation of rational prescribing in paediatrics.
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ABSTRACT:
SUBMITTER: Choonara I
PROVIDER: S-EPMC7970256 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundIrrational prescribing is a continuing public health issue in low/middle-income countries. This study evaluated the drug use pattern of medicines in paediatrics aged below 12 years attending the outpatient paediatric clinic of Bingham University Teaching Hospital, Nigeria.MethodAn observational cross-sectional study was conducted using patients' medical records who attended the outpatient paediatric clinic from 1 January to 30 April 2022. The WHO prescribing indicators and guidelines for investigating drug use in health facilities were used.ResultA total of 800 prescriptions containing 2723 drugs were analysed, with a mean number of drugs per prescription of 3.4. A total of 651 patients (81.3%) had at least one antibiotic, and the number of encounters with injection was 17.5% (140 patients). Prescribing by generic name was done for 1406 (51.6%) drugs; of the 2723 drugs prescribed, 2441 (89.6%) were from the WHO Pediatric Essential Medication List. In addition, 80% of the prescriptions contained antimalaria. Analgesics/antipyretics were the most frequently prescribed medicine (87.9%).ConclusionThe findings of this study deviated from the WHO recommended standards. There is a need to target paediatric clinics further and enforce national strategies to tackle non-standard prescribing practices among the paediatric population.
| S-EPMC9562308 | biostudies-literature
Project description:BackgroundInterventions designed to narrow the gap between research findings and clinical practice may be effective, but also costly. Economic evaluations are necessary to judge whether such interventions are worth the effort. We have evaluated the economic effects of a tailored intervention to support the implementation of guidelines for the use of antihypertensive and cholesterol-lowering drugs. The tailored intervention was evaluated in a randomized trial, and was shown to significantly increase the use of thiazides for patients started on antihypertensive medication, but had little or no impact on other outcomes. The increased use of thiazides was not expected to have an impact on health outcomes.Methods and findingsWe performed cost-minimization and cost-effectiveness analyses on data from a randomized trial involving 146 general practices from two geographical areas in Norway. Each practice was randomized to either the tailored intervention (70 practices; 257 physicians) or control group (69 practices; 244 physicians). Only patients that were being started on antihypertensive medication were included in the analyses. A multifaceted intervention was tailored to address identified barriers to change. Key components were an educational outreach visit with audit and feedback, and computerized reminders. Pharmacists conducted the visits. A cost-minimization framework was adopted, where the costs of intervention were set against the reduced treatment costs (principally due to increased use of thiazides rather than more expensive medication). The cost-effectiveness of the intervention was estimated as the cost per additional patient being started on thiazides. The net annual cost (cost minimization) in our study population was 53,395 US dollars, corresponding to 763 US dollars per practice. The cost per additional patient started on thiazides (cost-effectiveness) was 454 US dollars. The net annual savings in a national program was modeled to be 761,998 US dollars, or 540 US dollars per practice after 2 y. In this scenario the savings exceeded the costs in all but two of the sensitivity analyses we conducted, and the cost-effectiveness was estimated to be 183 US dollars.ConclusionsWe found a significant shift in prescribing of antihypertensive drugs towards the use of thiazides in our trial. A major reason to promote the use of thiazides is their lower price compared to other drugs. The cost of the intervention was more than twice the savings within the time frame of our study. However, we predict modest savings over a 2-y period.
| S-EPMC1472698 | biostudies-literature
Project description:BACKGROUND:The Objective Structured Clinical Examination (OSCE) has been used in pediatrics since the 1980s. Its main drawback is that large numbers of children are needed to make up for the fatigue factor inherent in prolonged testing periods. Also, examinations mainly include children between 7 and 16?years old. We describe the summative examination used in our institution to evaluate medical students' clinical competencies in pediatrics with realistic available resources and for a wider age-range. We also evaluated different factors known to influence medical students' performances. METHODS:This retrospective, descriptive, observational study evaluated the 740 distinct pediatric examination results of fourth-year medical students over 5 years. Their summative examination combined two different assessment methods: a structured real-patient examination (SRPE) using standardized assessment grids for the most frequent pediatric diagnoses, and a computer-based written examination (CBWE). RESULTS:Our approach defined an appropriate setting for some key elements of the educational objectives of pediatrics training, such as balancing the child-parent-pediatrician triangle and the ability to interact with pediatric patients, from newborns to 16-year-old adolescents, in a child-friendly fashion in realistic scenarios. SRPE scores showed no associations with students' degrees of exposure to specific lecture topics, vignettes, or bedside teaching. The impacts of clinical setting, topic, and individual examiners on SRPE scores was quite limited. Setting explained 1.6%, topic explained 4.5%, and examiner explained 4.7% of the overall variability in SRPE scores. CONCLUSIONS:By combining two different assessment methods, we were able to provide a best-practice approach for assessing clinical skills in Pediatrics over a wide range of real patients.
| S-EPMC7014729 | biostudies-literature
Project description: Not available
| S-EPMC1120523 | biostudies-literature
Project description:ObjectiveTo study antibiotic prescriptions among 0- to 4-year-old children before and after implementing a quality project on prudent prescribing of antibiotics in primary healthcare in the capital region of Iceland.DesignAn observational, descriptive, retrospective study using quantitative methodology.SettingPrimary healthcare in the Reykjavik area with a total population of approximately 220,000.SubjectsA total of 6420 children 0-4 years of age presenting at the primary healthcare centres in the metropolitan area over three years from 2016 to 2018.Main outcome measuresReduction of antibiotic prescriptions and change in antibiotic profile. Data on antibiotic prescriptions for children 0-4 years of age was obtained from the medical records. Out-of-hours prescriptions were not included in the database.ResultsThe number of prescriptions during the study period ranged from 263.6 to 289.6 prescriptions/1000 inhabitants/year. A reduction of 9% in the total number of prescriptions between 2017-2018 was observed. More than half of all prescriptions were for otitis media, followed by pneumonia and skin infections. Amoxicillin accounted for over half of all prescriptions, increasing between 2016 and 2018 by 51.3%. During this period, the prescribing of co-amoxiclav and macrolides decreased by 52.3% and 40.7%, respectively. These changes were significant in all cases, p < 0.0001.ConclusionThe results show an overall decrease in antibiotic prescribing concurrent with a change in the choice of antibiotics prescribed and in line with the recommendations presented in the prescribing guidelines implemented by the Primary Healthcare of the Capital Area, and consistent with the project's goals.Key pointsA substantial proportion of antibiotic prescribing can be considered inappropriate and the antibiotic prescription rate is highest in Iceland of the Nordic countries.After implementing guidance on the treatment of common infections together with feedback on antibiotic prescribing, a decrease in the total number of prescriptions accompanied by a shift in the antibiotic profile was observed.
| S-EPMC8475099 | biostudies-literature
Project description:BackgroundA gap exists between evidence and practice regarding the management of cardiovascular risk factors. This gap could be narrowed if systematically developed clinical practice guidelines were effectively implemented in clinical practice. We evaluated the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease.Methods and findingsWe conducted a cluster-randomized trial comparing a tailored intervention to passive dissemination of guidelines in 146 general practices in two geographical areas in Norway. Each practice was randomized to either the tailored intervention (70 practices; 257 physicians) or control group (69 practices; 244 physicians). Patients started on medication for hypertension or hypercholesterolemia during the study period and all patients already on treatment that consulted their physician during the trial were included. A multifaceted intervention was tailored to address identified barriers to change. Key components were an educational outreach visit with audit and feedback, and computerized reminders linked to the medical record system. Pharmacists conducted the visits. Outcomes were measured for all eligible patients seen in the participating practices during 1 y before and after the intervention. The main outcomes were the proportions of (1) first-time prescriptions for hypertension where thiazides were prescribed, (2) patients assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs, and (3) patients treated for hypertension or hypercholesterolemia for 3 mo or more who had achieved recommended treatment goals. The intervention led to an increase in adherence to guideline recommendations on choice of antihypertensive drug. Thiazides were prescribed to 17% of patients in the intervention group versus 11% in the control group (relative risk 1.94; 95% confidence interval 1.49-2.49, adjusted for baseline differences and clustering effect). Little or no differences were found for risk assessment prior to prescribing and for achievement of treatment goals.ConclusionsOur tailored intervention had a significant impact on prescribing of antihypertensive drugs, but was ineffective in improving the quality of other aspects of managing hypertension and hypercholesterolemia in primary care.
| S-EPMC1472695 | biostudies-literature
Project description:Mammalian pancreatic-type ribonucleases (ptRNases) comprise an enzyme family that is remarkably well suited for therapeutic exploitation. ptRNases are robust and prodigious catalysts of RNA cleavage that can naturally access the cytosol. Instilling cytotoxic activity requires endowing them with the ability to evade a cytosolic inhibitor protein while retaining other key attributes. These efforts have informed our understanding of ptRNase-based cytotoxins, as well as the action of protein-based drugs with cytosolic targets. Here, we address the most pressing problems encountered in the design of cytotoxic ptRNases, along with potential solutions. In addition, we describe assays that can be used to evaluate a successful design in vitro, in cellulo, and in vivo. The emerging information validates the continuing development of ptRNases as chemotherapeutic agents.
| S-EPMC3304445 | biostudies-literature
Project description:BACKGROUND:Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. METHODS:For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories 'social support', 'social learning', 'social normative pressures' and 'social contagion' to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks' potential impact on antibiotic prescribing. RESULTS:Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as a great asset, the main reason for membership and affirmative for own perspectives. All interviewed physicians (n =?27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflective management of antibiotic prescribing. Non-physician health professionals (n =?11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n =?7) expected networks and their members to be drivers for care optimization. CONCLUSION:Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics. TRIAL REGISTRATION:ISRCTN, ISRCTN58150046. Registered 24 August 2017.
| S-EPMC7073012 | biostudies-literature
Project description:Constrictive pericarditis is an uncommon disease in children, usually difficult to diagnose. We present the case of a 14-year-old boy with a previous history of tuberculosis and right heart failure, in whom constrictive pericarditis was diagnosed. The case highlights the need to integrate all information, including clinical data, noninvasive cardiac imaging, and even invasive hemodynamic evaluation when required, in order to establish the correct diagnosis and proceed to surgical treatment.
| S-EPMC4575721 | biostudies-literature
Project description:Pharmacogenomics (PGx) relates to the study of genetic factors determining variability in drug response. Implementing PGx testing in paediatric patients can enhance drug safety, helping to improve drug efficacy or reduce the risk of toxicity. Despite its clinical relevance, the implementation of PGx testing in paediatric practice to date has been variable and limited. As with most paediatric pharmacological studies, there are well-recognised barriers to obtaining high-quality PGx evidence, particularly when patient numbers may be small, and off-label or unlicensed prescribing remains widespread. Furthermore, trials enrolling small numbers of children can rarely, in isolation, provide sufficient PGx evidence to change clinical practice, so extrapolation from larger PGx studies in adult patients, where scientifically sound, is essential. This review paper discusses the relevance of PGx to paediatrics and considers implementation strategies from a child health perspective. Examples are provided from Canada, the Netherlands and the UK, with consideration of the different healthcare systems and their distinct approaches to implementation, followed by future recommendations based on these cumulative experiences. Improving the evidence base demonstrating the clinical utility and cost-effectiveness of paediatric PGx testing will be critical to drive implementation forwards. International, interdisciplinary collaborations will enhance paediatric data collation, interpretation and evidence curation, while also supporting dedicated paediatric PGx educational initiatives. PGx consortia and paediatric clinical research networks will continue to play a central role in the streamlined development of effective PGx implementation strategies to help optimise paediatric pharmacotherapy.
| S-EPMC9544158 | biostudies-literature